Fluoride Action Network

Tooth Decay

“The magnitude of [fluoridation's] effect is not large in absolute terms, is often not statistically significant and may not be of clinical significance.” - Ontario Ministry of Health and Long Term Care (1999).

Tooth Decay in F vs NF Countries

Fluoride advocates often claim that the reduction in tooth decay that has occurred since the 1950s is the result of the widespread introduction of fluoridated water. In 1999, for example, the Centers for Disease Control stated that “as a result [of water fluoridation], dental caries declined precipitously during the second half of the 20th century.” As support for this assertion, the CDC published the following figure:

SOURCE: Centers for Disease Control (1999). Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. MMWR 48:933-40.

What the CDC failed to mention is that tooth decay rates have “precipitously declined” in all western countries, irrespective of whether the country ever fluoridated its water. Indeed, most western countries do not fluoridate their water and yet their tooth decay rates have declined at the same rate as the U.S. and other fluoridated countries. This fact, which is widely acknowledged in the dental literature, can be quickly demonstrated by examining the World Health Organization’s (WHO) data on tooth decay trends in each country.  The following two figures and table, for example, compare the tooth decay trends in western countries with, and without, water (or salt) fluoridation.

DMFT (Decayed, Missing & Filled teeth) Status for 12 year olds by Country
– World Health Organization Data (2012) 
Country DMFTs Year Status*
Denmark 0.7 2008 No water fluoridation.
No salt fluoridation.
Germany 0.7 2005 No water fluoridation.
67% salt fluoridation.
England 0.7 2009 11% water fluoridation.
No salt fluoridation.
Netherlands* 0.8 2002 No water fluoridation.
No salt fluoridation.
Switzerland** 0.82 2009 No water fluoridation.
88% salt fluoridation.
Belgium 0.9 2009-10 No water fluoridation.
No salt fluoridation.
Sweden 0.9 2008 No water fluoridation.
No salt fluoridation.
Australia 1.0 2003-2004 80% water fluoridation.
No salt fluoridation.
Austria 1.0 2002
No water fluoridation.
6% salt fluoridation.
Ireland 1.1 2002 100% water fluoridation in study.
No salt fluoridation.
Italy 1.1 2004 No water fluoridation.
No salt fluoridation.
United States 1.19 1999-2004 64% water fluoridation.
No salt fluoridation.
Finland 1.2 2006 No water fluoridation.
No salt fluoridation.
France 1.2 2006 No water fluoridation.
65% salt fluoridation.
Spain 1.3 2004 11% water fluoridation.
10% salt fluoridation.
Greece 1.35 2005-06 No water fluoridation.
No salt fluoridation.
Iceland 1.4 2005 No water fluoridation.
No salt fluoridation.
New Zealand 1.4 2009 61% water fluoridation.
No salt fluoridation.
Japan 1.7 2005 No water fluoridation.
No salt fluoridation.
Norway 1.7 2004 No water fluoridation.
No salt fluoridation.
* The Hague | ** Zurich
Tooth Decay data from:

  • World Health Organization Collaborating Centre for Education, Training, and Research in Oral Health, Malmö University, Sweden. http://www.mah.se/CAPP/
Water fluoridation data from:
  • British Fluoridation Society (2012). One in a Million: The facts about water fluoridation. Available online at: http://www.bfsweb.org/onemillion/onemillion2012.html

Salt fluoridation data from:

  • Gotzfried F. (2006). Legal aspects of fluoride in salt, particularly within the EU. Schweiz Monatsschr Zahnmed 116:371-75.

To see published research on the decline of tooth decay in the western world and specific non-fluoridated countries, click here.

back to top